tbuckley/cabot-search huggingface dataset:
BI26 Treatment-induced scleroderma in a patient with metastatic melanoma
Authors: Daniel Yiu, Kara Heelan, Silvia Aguilar-Duran, Monica Terlizzo, Andrew Furness
Journal: British Journal of Dermatology (2023)

Abstract We present a 71-year-old woman who presented with sclerodermoid plaques affecting the abdomen and lower limbs, following a single cycle of nivolumab and ipilimumab 20 months prior for BRAF-mutant metastatic melanoma (pulmonary and hepatic metastases). Immunotherapy was discontinued owing to iatrogenic colitis, confirmed on flexible sigmoidoscopy, and requiring oral prednisolone, infliximab and, later, modified-release beclomethasone dipropionate. Owing to the progression of hepatic disease, she was commenced on targeted therapy with dabrafenib and trametinib. A lesional punch biopsy was performed; histological analysis demonstrated a dense dermis with mild chronic inflammatory infiltrate, in keeping with a diagnosis of scleroderma. Treatment with a combination of topical corticosteroids and vitamin D analogues improved disease from 15% body surface area (BSA) to 3% after 4 months. We performed a literature search in PubMed for articles on immunotherapy-related scleroderma published up to August 2022 and identified 18 articles that met our inclusion criteria. Scleroderma was reported in patients with melanoma, non-small-cell lung cancer, renal cell carcinoma, rectal adenocarcinoma, adenocarcinoma of the lung and large-cell neuroendocrine lung cancer treated with pembrolizumab, nivolumab, atezolizumab and ipilimumab. Latency of onset ranged from 0 to 18 months, and treatment included topical and systemic corticosteroids, mycophenolate mofetil, hydroxychloroquine, cyclophosphamide, infliximab and immunoglobulins, with varying treatment outcomes. There was no clear relationship between cancer subtype, duration of treatment and response to treatment. Furthermore, the lack of documented quantitative or semiquantitative measurements for improvement such as BSA and modified Rodnan skin score is limiting. Our case report is important in promoting the awareness of localized scleroderma as a rare side-effect of immunotherapy and highlights the various treatment options available.
GD01 (P25) Considering the burden of scabies alongside a mass drug administration treatment programme in an indigenous community in northern Australia
Authors: Victoria Cox, Michelle Dowden, Crystal Williams, Daniel Engelman, Jennifer Yan, Anna Ralph, Bart Currie, Joshua Francis
Journal: British Journal of Dermatology (2023)

Abstract Scabies is estimated to affect 455 million people worldwide and is one of 20 neglected tropical diseases recognized by the World Health Organization (WHO). It is caused by a parasitic mite infestation that is hyperendemic in low-resource regions, and the disease burden in northern Australia is believed to be among the highest in the world. However, few recent prevalence assessments have been conducted in northern Australia and it is not known whether historical assessments are still representative of the disease burden. Therefore, it is difficult to advocate for the allocation of government funding and resources without accurate information on the burden of disease. Considering the effectiveness of an ivermectin-based mass drug administration (MDA) treatment programme in northern Australia is important to explore a control strategy, following successful large trials conducted in the Pacific and recommendations from the WHO. The aim was to consider the burden of scabies and other skin conditions in an indigenous community in northern Australia, from undertaking a simplified skin assessment of all consenting community residents. An observational cross-sectional study design was used for this purpose. Five field teams covered different regions in Maningrida. The teams were comprised of a medical practitioner from the investigative team who worked alongside a local healthcare worker and an Aboriginal healthcare worker. All community residents who gave verbal consent were administered ivermectin, or topical permethrin cream if ivermectin was contraindicated, as part of a MDA programme, which was locally developed and implemented by the Mala’la Health Service. Simplified skin examinations (n = 1306) were conducted in Maningrida during Healthy Skin Week from 14 to 18 November 2022, with verbal consent from 99% of community residents approached for recruitment to undergo a simplified skin assessment and administration of ivermectin as part of the MDA treatment programme. The point prevalence for scabies was 25.2% (330 individuals). Ninety-three people (7.1%) were diagnosed with impetigo, and ∼40% of community residents had evidence of skin disease. No study participants were diagnosed with crusted scabies. Scabies is endemic in indigenous communities in northern Australia. This was the first prevalence assessment to be conducted in the Northern Territory since the East Arnhem Healthy Skin Project, which concluded in 2007, and the first MDA treatment programme conducted by an aboriginal medical service as a local health intervention. The consideration of effective rapid mapping and regional control strategies is essential to tailor a public health response that addresses the high burden of skin disease in northern Australia.
P63 Effectiveness of an image-analysing artificial intelligence-based digital health technology to diagnose nonmelanoma skin cancer and benign skin lesions
Authors: Helen Marsden, Ioulios Palamaras, Polychronis Kemos, Jack Greenhalgh
Journal: British Journal of Dermatology (2023)

Abstract Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are common types of nonmelanoma skin cancer (NMSC). The DERM-003 study was a prospective, multicentre, single-arm, masked study that aimed to demonstrate the effectiveness of an artificial intelligence-based digital health technology (AI-DHT) to identify SCC, BCC and premalignant conditions in dermoscopic images of suspicious skin lesions. Patients with at least one suspicious skin lesion that was suitable for photography were eligible. Each lesion was photographed with three smartphone cameras (iPhone 6S, iPhone 11 and Samsung 10) with a dermoscopic lens attached. Each image was assessed by the AI-DHT. A clinical diagnosis was made by the dermatologist, and histopathology results were obtained for biopsied lesions. The AI-DHT output was compared with the histopathology diagnosis, and the area under the receiver operating characteristic curve (AUROC) was calculated. Secondary endpoints included other diagnostic measures and assessment of premalignant lesions. Altogether, 572 patients (49.5% female, mean age 68.5 years, 96.9% Fitzpatrick skin types I–III) were recruited from four UK National Health Service trusts, providing images of 611 suspicious lesions. There were no exclusion criteria relating to skin type. In total, 592 lesions had images from all three cameras available; only one lesion had no images available. Altogether, 395 lesions had a histopathology result. Forty-seven biopsied lesions were diagnosed as SCC and 184 as BCC. The AUROCs for images taken by the iPhone 6S were 0.88 [95% confidence interval (CI) 0.83–0.93] for SCC and 0.87 (95% CI 0.84–0.91) for BCC. For Samsung 10, the AUROCs were 0.85 (95% CI 0.79–0.90) and 0.87 (95% CI 0.83–0.90), and for iPhone 11, they were 0.88 (95% CI 0.84–0.93) and 0.89 (95% CI 0.86–0.92) for SCC and BCC, respectively. Using images taken on iPhone 6S of biopsied-only lesions, the sensitivity rates in detecting SCC and BCC were 98% (95% CI 88–100) and 94% (95% CI 90–97), respectively; the specificity rates were 38% (95% CI 33–44) and 28% (95% CI 21–35), respectively; the positive predictive values were 17% (95% CI 16–19) and 59% (95% CI 56–61), respectively; and the NPVs were 99% (95% CI 95–100) and 81% (95% CI 70–89), respectively. All 12 lesions diagnosed as Bowen disease were classified correctly by the AI-DHT. Of the 61 lesions diagnosed as actinic keratosis, 52 were correctly classified of the 22 lesions diagnosed as dysplastic and 18 were correctly classified by the AI-DHT. All 16 lesions diagnosed as melanoma were classified as such by the AI-DHT. The AI-DHT has the potential to support the diagnosis of NMSC and premalignant lesions.
PA02 A teenager with a bleeding neck nodule
Authors: Paula Finnegan, Muriel Sadlier
Journal: British Journal of Dermatology (2023)

Abstract A 14-year-old boy was referred to dermatology with a new bleeding lesion on his right neck that had grown rapidly. There was no preceding history of trauma. Physical examination revealed a discrete eroded pink nodule measuring 10 × 9 mm on his right neck. Dermoscopic examination showed a central area of ulceration, with polymorphous vessels, white lines and multiple shades of pink and milky-white areas. This was excised. Histology confirmed the diagnosis of ulcerated superficial spreading malignant melanoma with a Breslow thickness of 4.8 mm (pT4b). BRAF v600e mutation was present. Initial staging with sentinel lymph node biopsy and whole-body positron emission tomography/­computed tomography were clear, but 6 months after presentation, he developed right-sided cervical lymphadenopathy and a parotid mass that was confirmed to be metastatic disease. Following a right parotidectomy and neck dissection, he was commenced on adjuvant treatment with dabrafenib and trametinib. He remains under close follow-up. Less than 1% of all melanomas are diagnosed in patients younger than 20 years of age. Most paediatric cases occur in adolescence (between 15 and 19 years of age). The majority arise sporadically. Risk factors for melanoma in childhood include giant congenital melanocytic naevi, personal history of malignancy, family history of melanoma, multiple (&amp;gt; 50) melanocytic naevi, history of sunburn or tanning-bed use, immunosuppression or genodermatoses (e.g. xeroderma pigmentosum). Most clinicians are familiar with the ‘ABCDE’ tool (asymmetry, border irregularity, colour variegation, diameter &amp;gt; 6 mm, evolution) used to help with the recognition of melanomas; however, melanoma in children often presents in an atypical fashion. Paediatric melanomas often lack pigment (amelanotic) and are nodular, and so may be misdiagnosed. Because of this, diagnosis may be delayed and patients often present with thicker tumours and lymph node involvement. To facilitate earlier diagnosis, modified ABCD detection criteria have been proposed for paediatric melanoma (amelanosis, bleeding/bump, colour uniformity, de novo development) that can be used in conjunction with the established ABCDE approach. The CUP criteria have also been described (colour that is pink/red/changing, ulceration/upward thickness, pyogenic granuloma-like lesions/pop-up of new lesions). Evolution remains an important point to consider when suspecting melanoma in patients of any age. Management and staging of paediatric melanoma is adopted from the American Joint Committee on Cancer melanoma staging system guidelines for adult melanoma. Currently, there are no specific guidelines for the management of melanoma in children. The mainstay of treatment is surgical resection. Sentinel lymph node biopsy should be considered with ulceration or a Breslow thickness of &amp;gt; 0.75 mm. Patients with stage III and IV melanoma should be considered for adjuvant immunotherapy. All patients with melanoma should be followed-up with regular skin examinations.
P22 Clinicopathologic characteristics of metastatic cutaneous squamous cell carcinoma: a cohort study
Authors: Nicholas Stefanovic, Alan Irvine, Niall Cosgrave, Lisa Killion, Patrick Ormond, Benvon Moran, Rupert Barry
Journal: British Journal of Dermatology (2023)

Abstract Cutaneous squamous cell carcinoma (cSCC) is a keratinocyte tumour with excellent prognosis following early-stage surgical treatment. Nevertheless, cSCC possesses an inherent potential for locoregional and distant metastasis in approximately 4% of cases, contributing to disease-specific mortality. Recent guidance on cSCC management risk stratifies patients based on clinicopathological factors to identify those patients most at risk of metastasis. A retrospective cohort study identified 3455 cSCCs arising in 2522 patients, via review of histopathological diagnoses of cSCC at a tertiary hospital in Dublin, Ireland, between the years of 2009 and 2019. The aim of the study was to describe adequately a large cohort of patients with metastatic cSCC and investigate factors associated with metastasis. Metastatic disease was identified by histopathological and/or radiological confirmation in 116 patients, with complete data available in 105 cases. Twenty-two (21%) were female. Mean age at primary tumour diagnosis was 74.8 years and mean time to first metastasis was 0.8 years. Twenty-six (25%) patients were immunosuppressed, the commonest reason for which was haematological malignancy. Median (SD) size of the primary tumour was 36 (21.65) mm and median depth was 10 (7.43) mm. Eighty-six (82%) tumours were located on the head and neck. Seventeen (16%) of the tumours were recurrent, 58 (55%) were &amp;gt; 20 mm, 38 (36%) demonstrated extension beyond subcutaneous fat, 22 (21%) demonstrated lymphovascular invasion, 24 (23%) demonstrated perineural invasion of nerves &amp;gt; 0.1 mm in diameter and 41 (39%) tumours were poorly differentiated. Twenty-six patients developed distant metastatic disease in addition to nodal metastasis. In most patients in our cohort, AJCC 8th Edition histopathological high-risk cSCC features were absent, apart from size &amp;gt; 20 mm. Conversely, most patients exhibited at least one clinical high-risk cSCC feature as per the British Association of Dermatologists’ guidelines for the management of cutaneous squamous cell carcinoma, including advanced age and tumour location (Keohane SG, Botting J, Budny PG et al. British Association of Dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma 2020. Br J Dermatol 2021; 184:401–14). All patients were discussed at a specialist skin multidisciplinary team meeting, with significant variability noted in preoperative imaging, depending on the primary treating specialty. This cohort illustrates the importance of risk stratification of cSCC on clinicopathological features. This facilitates management decisions and ongoing patient surveillance with a view to preventing disease-specific morbidity and mortality.
PS05 A qualitative assessment of the impact of hidradenitis suppurativa on sexual function
Authors: Julian Pearce, Leila Ferguson, Catriona Maybury, Natalie Loibner, Ruth Lamb
Journal: British Journal of Dermatology (2023)

Abstract Hidradenitis suppurativa (HS) is associated with significant physical and psychosocial morbidity. There are limited data in the literature on the impact of the condition on patients’ psychological, physical and emotional sexual functioning and wellbeing. A patient survey was collaboratively designed by dermatologists and a clinical psychologist to assess sexual function in HS. This was adapted from existing published scales assessing components of sexual functioning, as there is no validated tool for use in HS. Nineteen patients (10 men and nine women) with HS were surveyed. They had a mean age of 41 years and a mean Hurley stage of 2.2. Twenty-six per cent (n = 5) were current smokers. The mean body mass index of participants was 28 kg m−2. Seventy-nine per cent (n = 15) were in a current sexual relationship. Seventy-four per cent (n = 14) felt that HS affected their sexual relationships negatively and 50% (n = 8/16) documented that HS had prevented them starting a new sexual relationship. Eighty-four per cent (n = 16) reported that their HS caused them to avoid sexual intimacy. Sixty-three per cent (n = 12) suffered a degree of dyspareunia and 63% (n = 12) described that odour from HS lesions impacted negatively on sexual activity. Confidence with regard to emotional closeness with partners during sex was variable, with 31% (n = 5) reporting low confidence; 58% (n = 11) had low confidence when engaging in sexual activity. Fifty per cent (n = 9/18) felt sad when considering the impact of HS on their sexual life and 88% (n = 14/16) felt ashamed and stressed when considering being naked or intimate. Ninety-four per cent (n = 17/18) felt a degree of sexual unattractiveness due to HS, with 44% (n = 8/18) rating it as ‘extremely’ or ‘very much’. Eighty-nine per cent (n = 16/18) reported that HS had negatively impacted on the sexual quality of their lives, with 33% (n = 6) rating it as ‘extremely’ or ‘very much’. Sexual function in HS is an important, often overlooked component of quality of life. Sexual dysfunction is of particular concern in HS due to the location and nature of lesions, which are often close to or affect erogenous zones (Varney P, Guo W, Brown M et al. A systematic review and meta-analysis of sexual dysfunction in patients with hidradenitis suppurativa. Int J Dermatol 2022; 85:AB23). This study demonstrates that HS has a significant impact on patients’ psychosexual, physical and emotional sexual functioning and wellbeing. The Permission, Limited Information, Specific Suggestions, Intensive Therapy model is a useful, structured framework for clinicians to incorporate the discussion and management of sexual dysfunction into consultations, and clinicians should work with local psychological, sexual and biomedical services to address any identified morbidity.
DS20 Longevity of patients following Mohs micrographic surgery for the treatment of basal cell carcinomas
Authors: Mina M Raahimi, James Bonnick, Sophie Stoneham, Stephen Keohane
Journal: British Journal of Dermatology (2023)

Abstract Basal cell carcinomas (BCCs) are slow-growing, nonaggressive skin cancers (metastatic rate &amp;lt; 0.1%). They are common, especially in the elderly population (Sreekantaswamy S, Endo J, Chen A et al. Aging and the treatment of basal cell carcinoma. Clin Dermatol 2019; 37:373–8). Basal cell carcinoma guidelines recommend Mohs micrographic surgery (MMS) for primary high-risk BCCs and high-risk recurrent BCCs suitable for surgery (Mosterd K, Krekels GA, Nieman FH et al. Surgical excision vs. Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncol 2008; 9:1149–56). Mohs micrographic surgery allows for the removal of the tumour in stages with rapid processing of specimens using frozen section analysis. Complete surgical margins are analysed in near real time. It has, compared with other treatments, lower recurrence rates (&amp;lt; 1%) and often better cosmetic outcomes, but it has higher costs and longer operating times (Sreekantaswamy et al.; Mosterd et al.). Factors that need to be considered when deciding on treatment options are comorbidities, performance status and the risk of causing harm if left untreated. The term ‘lag time to benefit’ entails not only looking at how effective a specific treatment is, but also when a treatment will become beneficial in relation to the patient’s life expectancy (Sreekantaswamy et al.). In patients with a limited life expectancy, nonsurgical treatment can be an appropriate and possibly even the preferred choice (Sreekantaswamy et al.). A retrospective single-centre review of all available BCC MMS patient data from January 2011 to December 2017 was performed. Patients from out of area or with tumour syndromes were excluded. Survival rates following MMS were recorded. Of the 2518 patients reviewed, 1905 met the inclusion criteria. In total, 357 (18.7%) were aged ≥ 80 years; at 5 years post-MMS, 24% and 30.7% of the 80–89-year-old females and males had died, respectively, suggesting they had a higher life expectancy than the same general demographic. It would be interesting to compare these results with survival rates following other treatments, such as conventional excision or curettage and cautery. Limitations include missing documentation (n = 258) and not all internal logs being tracked appropriately (19.6% were not tracked, n = 615/3133). We propose a patient-centred, tailored approach to the treatment of BCCs. Based on the fundamental ethical principles, informed and effective shared decision-making is vital; patient values, preferences and experiences should also be considered.
DP17 A very rare presentation of linear IgA disease during pregnancy
Authors: Christopher Phillips, Sabrina Khan, Olivia Espinosa, Antonia Lloyd-Lavery
Journal: British Journal of Dermatology (2023)

Abstract We present a very rare immunobullous dermatosis, linear IgA disease (LAD), that developed during pregnancy, to highlight its clinical features, management and important safety considerations for the neonate. During her first pregnancy, a 32-year-old Japanese woman of 27 weeks’ gestation developed an intensely itchy blistering rash on her limbs, trunk and face without periumbilical predilection. The blisters were tense, clustering in an annular configuration, with subsequent development of blistering and erosions involving the oral and genital mucosae. Medications included a pregnancy multivitamin only. A lesional skin biopsy revealed a subepidermal blister containing neutrophils and eosinophils. Direct immunofluorescence of perilesional skin demonstrated linear deposition of IgA along the basement membrane zone. Linear IgA disease was diagnosed. Initial treatment consisted of erythromycin and daily clobetasol ointment. Owing to inadequate symptom control and blister progression, dapsone 50 mg daily was initiated with prompt improvement in her condition and cessation of new blistering. A postpartum flare necessitated a dose increase to 75 mg daily. Her baby’s glucose-6-phosphate dehydrogenase (G6PD) level was found to be normal at birth. She proceeded to breastfeed her son, and monitoring of his haemoglobin level was normal. Although her clinical presentation initially raised the possibility of pemphigoid gestationis (PG), there was no periumbilical involvement, and the morphology of blistering in conjunction with mucosal involvement was more suggestive of LAD. The immunofluorescence results also helped to distinguish LAD from PG. The new onset of LAD during pregnancy is very unusual and has been rarely reported (Ikkaku N, Tateishi N, Oda Y et al. Linear immunoglobulin A bullous dermatosis developing during late pregnancy. J Dermatol 2017; 44:e44–5). Pre-existing LAD typically improves during pregnancy, although postpartum flares are recognized. Pemphigoid gestationis has been associated with an increased risk of prematurity and intrauterine growth restriction, but this has not been reported with LAD during pregnancy, possibly due to its rarity. Both the diagnosis of LAD and its mainstay treatment—dapsone—have important potential implications for the neonate. As for other immunobullous diseases, transplacental transfer of pathogenic antibodies may result in transient, usually mild, neonatal blistering. Although dapsone can be safely used during pregnancy and breastfeeding, the risk of neonatal haemolysis and methemoglobinaemia necessitates the assessment of the G6PD level and haemoglobin monitoring in the neonate. Multidisciplinary input from the dermatology, obstetric and paediatric teams is crucial to ensure appropriate counselling and care of the affected mother and baby.